Full-thickness skin grafts in nasal reconstruction: A retrospective study

Sciences, Mayo Clinic, Scotts-dale, Arizona c ; and Advanced Dermatology and Cosmetic Surgery, Jacksonville, Florida. d

To the Editor: The nose is the most common site for skin cancer on the head and neck. 1 In appropriately selected patients, utilizing an optimal donor site, full-thickness skin grafts (FTSGs) can provide excellent functional and cosmetic outcomes. 2This study reports our experience with FTSG to repair nasal defects.
We conducted a retrospective chart review from 2008 to 2018 at our institution's Arizona and Florida campuses.Cases were identified using the billing codes 15260 plus 17311.Inclusion criteria included Mohs micrographic surgery performed on the nose with same day repair with FTSG.A total of 544 cases were identified.Surgical complications were defined as hematoma, partial or complete graft failure, donor-site infection, and FTSG-site infection.
This study presents the postoperative results of 542 patients who underwent the FTSG repair to reconstruct nasal defects, demonstrating that FTSGs represent a viable, cosmetically sound reconstruction option regardless of the nasal subunit (Fig 1).In our study, patients who underwent nasal FTSG experienced a very low postoperative complication rate (3.9%), compared to previous literature reports ranging from 11.7 to 18.3%. 3,4There was no significant difference in donor site, postoperative defect diameter, and graft surface area between cases with and without complications.Of the 10 patients who experienced postoperative complications of the graft site, 8 did not have a bolster dressing applied to their graft.Although the number of complications in our study was too low to have power to detect statistically significant differences, it suggests that bolster dressings may assist with graft take 5 and play a protective role in preventing graft-site complications.In addition, complication rates were not increased for transplant patients, active smokers, or patients on systemic anticoagulation.This suggests that FTSG can be safely considered in patients with risk factors for surgical complications, although we acknowledge that the limited power of our study may not fully highlight the consequences of these risk factors.Of note, patients on systemic anticoagulation were routinely counseled to continue anticoagulation, whereas counseling regarding smoking cessation was more variable and patient/ surgeon dependent.Lastly, use of FTSG allowed for acceptable aesthetic outcomes, with only 5.7% of patients requiring a form of scar refinement.
In conclusion, our findings show that FTSGs are a versatile, safe, and aesthetically sound option for single-staged reconstruction of nasal defects.Additionally, the use of bolsters may decrease the likelihood of a postoperative complication.

Fig 1 .
Fig 1. Full-thickness skin graft reconstructions.A, Initial defect.B, After graft placement.C, Four months after reconstruction.D, Initial defect.E, After graft placement.F, Four months after reconstruction.G, Initial defect.H, After graft placement.I, Four months after reconstruction.

Table I .
Patient characteristics and surgery outcomes by complication status %, Percentage; BCC, basal cell carcinoma; cm, centimeter; MIS, melanoma in situ; MM, malignant melanoma; n, number; SCC, squamous cell carcinoma.